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Adherence to national diabetes guidelines through monitoring quality indicators--A comparison of three types of care for the elderly with special emphasis on HbA1c.

https://arctichealth.org/en/permalink/ahliterature271560
Source
Prim Care Diabetes. 2015 Aug;9(4):253-60
Publication Type
Article
Date
Aug-2015
Author
Ann-Sofie Nilsson Neumark
Lars Brudin
Thomas Neumark
Source
Prim Care Diabetes. 2015 Aug;9(4):253-60
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Biomarkers - blood
Blood Glucose - drug effects - metabolism
Cross-Sectional Studies
Diabetes Mellitus, Type 1 - blood - diagnosis - drug therapy - epidemiology
Diabetes Mellitus, Type 2 - blood - diagnosis - drug therapy - epidemiology
Female
Guideline Adherence - standards
Health Services for the Aged - standards
Hemoglobin A, Glycosylated - metabolism
Home Care Services
Homes for the Aged
Humans
Hypoglycemic Agents - adverse effects - therapeutic use
Independent living
Male
Nursing Homes
Practice Guidelines as Topic - standards
Practice Patterns, Physicians' - standards
Prevalence
Process Assessment (Health Care) - standards
Quality Indicators, Health Care - standards
Sweden - epidemiology
Treatment Outcome
Abstract
To compare adherence to Swedish guidelines for diabetes care between elderly people living at home with or without home health care, and residents of nursing homes.
Medical records of 277 elderly people aged 80 and older, with known diabetes in a Swedish municipality, were monitored using quality indicators to evaluate processes and outcomes.
Monitoring, in accordance to diabetes guidelines, of HbA1c, lipids, blood pressure and foot examinations was lower among residents of nursing homes (p
PubMed ID
25865853 View in PubMed
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[Analysis of quality data based on national clinical databases].

https://arctichealth.org/en/permalink/ahliterature148514
Source
Ugeskr Laeger. 2009 Sep 14;171(38):2723-7
Publication Type
Article
Date
Sep-14-2009
Author
Jan Utzon
Anette Lykke Petri
Sten Christophersen
Author Affiliation
Enhed for Klinisk Kvalitet, Region Hovedstaden, Bispebjerg Hospital, DK-2400 København NV. janutzon@dadlnet.dk
Source
Ugeskr Laeger. 2009 Sep 14;171(38):2723-7
Date
Sep-14-2009
Language
Danish
Publication Type
Article
Keywords
Confounding Factors (Epidemiology)
Data Collection - standards
Data Interpretation, Statistical
Databases, Factual - standards
Denmark
Humans
Internet
Quality Assurance, Health Care
Quality Indicators, Health Care - standards
Registries - standards
Selection Bias
Abstract
There is little agreement on the philosophy of measuring clinical quality in health care. How data should be analyzed and transformed to healthcare information is an ongoing discussion. To accept a difference in quality between health departments as a real difference, one should consider to which extent the selection of patients, random variation, confounding and inconsistency may have influenced results. The aim of this article is to summarize aspects of clinical healthcare data analyses provided from the national clinical quality databases and to show how data may be presented in a way which is understandable to readers without specialised knowledge of statistics.
PubMed ID
19758494 View in PubMed
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["Appoint a Swedish Neuberger commission"].

https://arctichealth.org/en/permalink/ahliterature259592
Source
Lakartidningen. 2014 Sep;111(37):1522-3
Publication Type
Article
Date
Sep-2014
Author
Bengt Järhult
Source
Lakartidningen. 2014 Sep;111(37):1522-3
Date
Sep-2014
Language
Swedish
Publication Type
Article
Keywords
Delivery of Health Care - economics - organization & administration - standards
Humans
Quality Indicators, Health Care - standards
Quality of Health Care
Registries - standards
Sweden
Notes
Comment In: Lakartidningen. 2014 Sep;111(37):152325325107
PubMed ID
25325106 View in PubMed
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Association between rehabilitation care practices and care quality in long-term care facilities.

https://arctichealth.org/en/permalink/ahliterature158250
Source
J Nurs Care Qual. 2008 Apr-Jun;23(2):155-61
Publication Type
Article
Author
Pia Vähäkangas
Anja Noro
Harriet Finne-Soveri
Magnus Björkgren
Author Affiliation
Chydenius Institute, Jyväskylä University, Kokkola, Finland. pia.vahakangas@chydenius.fi
Source
J Nurs Care Qual. 2008 Apr-Jun;23(2):155-61
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Bed Rest - statistics & numerical data
Cross-Sectional Studies
Fecal Incontinence - epidemiology
Female
Finland - epidemiology
Geriatric Assessment
Humans
Length of Stay - statistics & numerical data
Linear Models
Long-Term Care - standards
Male
Multivariate Analysis
Nursing Assessment
Nursing Evaluation Research
Outcome Assessment (Health Care)
Pressure Ulcer - epidemiology
Prevalence
Quality Indicators, Health Care - standards
Rehabilitation Nursing - standards
Skilled Nursing Facilities - organization & administration
Urinary Incontinence - epidemiology
Abstract
This article analyzes the association between rehabilitation care practices and quality outcomes in Finland and represents unit-level (n = 256) associations between rehabilitation nursing and quality outcomes. Units classified as units providing a high frequency of rehabilitation care practices had better outcomes in 2 of 5 quality outcomes.
PubMed ID
18344782 View in PubMed
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Best practices in scleroderma: an analysis of practice variability in SSc centres within the Canadian Scleroderma Research Group (CSRG).

https://arctichealth.org/en/permalink/ahliterature122345
Source
Clin Exp Rheumatol. 2012 Mar-Apr;30(2 Suppl 71):S38-43
Publication Type
Article
Author
Sarah Harding
Sarit Khimdas
Ashley Bonner
Murray Baron
Janet Pope
Author Affiliation
University of Western Ontario, London, ON, Canada. sarahharding@rcsi.ie
Source
Clin Exp Rheumatol. 2012 Mar-Apr;30(2 Suppl 71):S38-43
Language
English
Publication Type
Article
Keywords
Benchmarking - standards
Canada
Consensus
Databases, Factual
Diagnostic Tests, Routine - standards
Evidence-Based Medicine - standards
Female
Guideline Adherence - standards
Humans
Male
Middle Aged
Outcome and Process Assessment (Health Care) - standards
Physician's Practice Patterns - standards
Practice Guidelines as Topic - standards
Predictive value of tests
Prospective Studies
Quality Indicators, Health Care - standards
Rheumatology - standards
Scleroderma, Systemic - complications - diagnosis - therapy
Severity of Illness Index
Time Factors
Treatment Outcome
Abstract
There is currently no consensus on best practice in systemic sclerosis (SSc). To determine if variability in treatment and investigations exists, practices among Canadian Sclerodermia Research Group (CSRG) centres were compared.
Prospective clinical and demographic data from adult SSc patients are collected annually from 15 CSRG treatment centres. Laboratory parameters, self-reported socio-demographic questionnaires, current and past medications and disease outcome measures are recorded. For centres with >50 patients enrolled, treatment practices were analysed to determine practice variability.
Data from 640 of 938 patients within the CSRG database met inclusion criteria, where 87.3% were female, the mean ± SEM age was 55.3±0.5, 48.9% had limited SSc and 47.8% had diffuse SSc (and 3.3% uncharacterised). Some investigation and treatment practices were inconsistent among 6 centres including proportion receiving: PDE5 (phosphodiesterase type 5) inhibitors for Raynaud's phenomenon (p=0.036); cyclophosphamide (p=0.037) and azathioprine (p=0.037) for treatment of ILD; and current use of D-penicillamine, although uncommon, varied among sites. Annual echocardiograms and PFTs were frequently done and did not vary among sites but the rate of pulmonary arterial hypertension (PAH) was directly related to site size and this was not the case for other organ involvement.
Despite routine tests within a database, site variation in SSc with respect to investigations and management among CSRG centres exists suggesting a need for a standardised approach to the investigation and treatment of SSc. One can speculate that larger centres are more export in detecting PAH.
PubMed ID
22691207 View in PubMed
Less detail
Source
Acta Neurochir (Wien). 2011 Jun;153(6):1237-43; author reply 1245
Publication Type
Article
Date
Jun-2011
Author
Ole Solheim
Johan Cappelen
Source
Acta Neurochir (Wien). 2011 Jun;153(6):1237-43; author reply 1245
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Adult
Brain Neoplasms - mortality - surgery
Centralized Hospital Services - standards
Cerebellar Neoplasms - mortality - surgery
Child
Child, Preschool
Clinical Competence - standards
Craniotomy - mortality
Cross-Cultural Comparison
Female
Health Facility Size - standards
Humans
Infant
Male
Medulloblastoma - mortality - surgery
Neuroectodermal Tumors, Primitive - mortality - surgery
Norway
Postoperative Complications - mortality
Quality Indicators, Health Care - standards
Registries
Specialties, Surgical
Survival Analysis
Notes
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PubMed ID
21541685 View in PubMed
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Canadian Association of Gastroenterology consensus guidelines on safety and quality indicators in endoscopy.

https://arctichealth.org/en/permalink/ahliterature127304
Source
Can J Gastroenterol. 2012 Jan;26(1):17-31
Publication Type
Conference/Meeting Material
Article
Date
Jan-2012
Author
David Armstrong
Alan Barkun
Ron Bridges
Rose Carter
Chris de Gara
Catherine Dube
Robert Enns
Roger Hollingworth
Donald Macintosh
Mark Borgaonkar
Sylviane Forget
Grigorios Leontiadis
Jonathan Meddings
Peter Cotton
Ernst J Kuipers
Author Affiliation
Division of Gastroenterrology, McMaster University, Hamilton, Ontario, Canada. armstro@mcmaster.ca
Source
Can J Gastroenterol. 2012 Jan;26(1):17-31
Date
Jan-2012
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Ambulatory Care Facilities - standards
Canada
Clinical Competence - standards
Endoscopy, Gastrointestinal - education - standards
Humans
Informed Consent - standards
Patient Discharge - standards
Quality Indicators, Health Care - standards
Abstract
Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy.
To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery.
A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants.
Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified.
The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services.
The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy.
Notes
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PubMed ID
22308578 View in PubMed
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Canadian quality indicators for percutaneous coronary interventions.

https://arctichealth.org/en/permalink/ahliterature153910
Source
Can J Cardiol. 2008 Dec;24(12):899-903
Publication Type
Article
Date
Dec-2008
Author
Dennis T Ko
Harindra C Wijeysundera
Xiaofu Zhu
Janice Richards
Jack V Tu
Author Affiliation
Institute for Clinical Evaluative Sciences, Ontario, Canada. dennis.ko@ices.on.ca
Source
Can J Cardiol. 2008 Dec;24(12):899-903
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Angioplasty, Balloon, Coronary - mortality - standards
Benchmarking
Canada
Coronary Disease - mortality - radiography - therapy
Delphi Technique
Evidence-Based Medicine
Female
Guideline Adherence
Health Care Surveys
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Physician's Practice Patterns - standards
Practice Guidelines as Topic
Quality Indicators, Health Care - standards
Sensitivity and specificity
Survival Analysis
Treatment Outcome
Abstract
Quantifying adherence to quality indicators can serve as a direct measure of quality of care and provide the foundation for quality improvement. However, quality indicators for percutaneous coronary intervention (PCI) have not been developed in Canada.
To develop a set of quality and outcome indicators for PCI that can be used across Canada.
A 12-member national expert panel was selected to represent practice in different regions of Canada. Potential quality indicators were identified by a detailed search of published guidelines, randomized trials and outcomes studies. A two-step modified Delphi process was employed with an initial screening round of indicator ratings, followed by a national quality indicator panel meeting, and follow-up discussions to obtain consensus.
A total of 26 indicators including six structure indicators, nine process indicators, and 11 outcomes indicators were identified by the national expert panel to be representative of high quality of care for PCI. Pharmacological indicators included prescription of acetylsalicylic acid, clopidogrel and statin therapy as adjunctive therapy for PCI. Nonpharmacological process indicators included minimal procedure volumes, door-to-balloon time in primary PCI, prevention of contrast-induced nephropathy and selected patient education counselling instructions. Outcome indicators included death, myocardial infarction, target vessel revascularization and vascular access complications after PCI.
A new set of PCI quality indicators for use in the Canadian health care system was developed. The widespread adoption and implementation of PCI quality indicators in clinical practice will facilitate the identification of practice gaps to enable quality improvement efforts and to optimize the outcomes of patients undergoing PCI throughout Canada.
Notes
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PubMed ID
19052669 View in PubMed
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Can patient injury claims be utilised as a quality indicator?

https://arctichealth.org/en/permalink/ahliterature130906
Source
Health Policy. 2012 Feb;104(2):155-62
Publication Type
Article
Date
Feb-2012
Author
Jutta Järvelin
Unto Häkkinen
Author Affiliation
Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland. jutta.jarvelin@thl.fi
Source
Health Policy. 2012 Feb;104(2):155-62
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Hip - adverse effects - legislation & jurisprudence - statistics & numerical data
Arthroplasty, Replacement, Knee - adverse effects - legislation & jurisprudence - statistics & numerical data
Compensation and Redress - legislation & jurisprudence
Female
Finland
Humans
Male
Malpractice - statistics & numerical data
Medical Errors - legislation & jurisprudence - statistics & numerical data
Middle Aged
Quality Indicators, Health Care - standards
Abstract
To examine the association between patient injury claims and well-known quality indicators and to assess whether claims can be utilised in performance measurement.
Data were derived from administrative registers and comprised hip and knee replacement patients (n=34181) in Finland from 1998 to 2003. Hospital-level correlations were calculated between claims and quality indicators (5-year revision rate, 1-year deep infection rate, and 14-day readmission rate), while logistic regression analysis was used to analyze patient-level data for an association between claims and quality indicators.
Correlations between claims and revisions as well as claims and infections were statistically significant, with correlation coefficients ranging from 0.21 to 0.62. In the regression analysis, both the revision and the infection indicator had a positive and statistically significant association with filing a claim (OR 1.002; 95% CI 1.001-1.003 and 1.001; 1.00005-1.001, respectively) and obtaining compensation (1.003; 1.001-1.005 and 1.001; 1.0003-1.002, respectively).
A claims indicator has the potential to be applied as a quality indicator. It should be complemented, however, with other indicators or actions to improve its acceptability by health professionals and to mitigate its possible undesirable effects.
PubMed ID
21956047 View in PubMed
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Care in labor: a Swedish survey using the Bologna Score.

https://arctichealth.org/en/permalink/ahliterature91065
Source
Birth. 2008 Dec;35(4):321-8
Publication Type
Article
Date
Dec-2008
Author
Sandin-Bojö Ann-Kristin
Kvist Linda J
Author Affiliation
Division for Health and Caring Sciences, Karlstad University, Karlstad, Sweden.
Source
Birth. 2008 Dec;35(4):321-8
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Adult
Birthing Centers - organization & administration
Cross-Sectional Studies
Delivery, Obstetric - methods - nursing - standards
Evidence-Based Practice
Female
Health Knowledge, Attitudes, Practice
Humans
Labor, Obstetric
Midwifery - methods - standards - statistics & numerical data
Nurse-Patient Relations
Obstetrics and Gynecology Department, Hospital
Perinatal Care - methods - standards
Pregnancy
Prospective Studies
Quality Indicators, Health Care - standards
Questionnaires
Sweden
Abstract
BACKGROUND: An important part of midwives' area of responsibility is to strive to keep birth normal. Interventions during childbirth are costly and may disrupt the course of normal labor. The aim of this study was to describe, by use of the Bologna Score, how birth is managed in Sweden. METHODS: A prospective cross-sectional study in a national sample was performed. All (n = 51) Swedish maternity units were invited to participate and 36 (70.6%) agreed. Midwives collected data, in accordance with the Bologna Score, for all deliveries occurring during a 2-week period in 2007. RESULTS: Qualified health personnel assisted at almost all deliveries (99.9%), and a vaginal birth was planned for 84 percent of the women. A Bologna Score of 5 signifies that birth has been managed using recommended evidence-based practice, which was achieved for 22.7 percent of the planned vaginal births. Use of the supine position and some interventions were responsible for loss of points. The percentage of 5-point scores varied greatly among units (0-53.1%). CONCLUSIONS: The findings suggest that in Sweden, birth is managed according to scientific evidence to a limited degree. Large differences among units also suggest that care in childbirth is based on attitudes rather than on scientific evidence. The Bologna Score was easy to use and gave a good picture of how care was given at the participating maternity units. We suggest that the instrument is useful as a quality indicator for intrapartum care.
PubMed ID
19036045 View in PubMed
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